Provider Demographics
NPI:1629472931
Name:JEFFREY LAFFERMAN
Entity Type:Organization
Organization Name:JEFFREY LAFFERMAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIC CONSULTANT
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBORA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:FLOYD
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:410-428-6032
Mailing Address - Street 1:912 SUN CIRCLE WAY
Mailing Address - Street 2:
Mailing Address - City:ESSEX
Mailing Address - State:MD
Mailing Address - Zip Code:21221-5946
Mailing Address - Country:US
Mailing Address - Phone:410-428-6032
Mailing Address - Fax:410-391-4381
Practice Address - Street 1:912 SUN CIRCLE WAY
Practice Address - Street 2:
Practice Address - City:ESSEX
Practice Address - State:MD
Practice Address - Zip Code:21221-5946
Practice Address - Country:US
Practice Address - Phone:410-428-6032
Practice Address - Fax:410-391-4381
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-15
Last Update Date:2014-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC5790261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)